Mental Health Update

Content Note – Discussion of suicidal ideation

So… I worked out a lot of the stress things that I was freaking out about that were exacerbating and exacerbated by my depression. It felt like everything was magically okay again! For about a day. Even now I’m feeling much less overwhelmed, I’m still not doing so great. I find it very difficult to really get into, well, anything. The video games I usually play for fun now feel like a chore half the time. This kind of defeats the purpose of video games, and is also depressing. When I read blog posts and stuff, I sometimes just suddenly lose interest halfway through. Satisfying my hunger feels like this annoying chore, now, and I put it off like one, too. Unless it involves buying tasty/unhealthy food, in which case I crave all the tasty things. Except that I cannot figure out what the tasty things I want are, because I’m tired of all the stuff I usually get and can’t think of other things I might enjoy (at least, none that are easily accessible).

Motivation currently feels like this thing that happens to other people. I don’t have much energy (but that’s been business as usual for I don’t even know how long), I don’t have much motivation, and I frequently can’t bring myself to care about the consequences of not doing the things I need to do. This is not a great combination for writing amazing term papers and finishing all of my homework and studying for finals. Or even for adhering to my bedtime so I don’t sleep through classes (strict bedtimes is the only reliable way I have found to wake up on time in the mornings, and even that can fail if I have a bout of insomnia). I think I might be able to manage half-assed term papers, though. I hope. Having a crappy paper is better than no paper, right?

I found out that therapists at universities can be remarkably helpful when you go see them during a “crisis”. I’m still not sure what “crisis” means (outside of suicidality being included in the category “crisis”), but when I broke down crying in front of my friend and then mentioned having vaguely thought of going over to the campus therapy place and see someone for same day counseling for being “in crisis”, they didn’t let me back out of it and walked me over there. My therapist worked things out with one of my professors to get me some extensions on the assignments I’d been feeling overwhelmed about, without me having to do much of anything aside from signing a release of information form. So that was cool. I have also been switched to twice a week appointments with my therapist for a bit, and I ended up with a next day appointment with my psychiatrist.

But the psychiatrist thing wasn’t super helpful. They gave me a prescription for something to help with performance anxiety and told me I was already on the maximum dosage for the anti-depressants I’m taking. I guess the anti-anxiety thing is kind of nice? I do get a lot of anxiety about public speaking, and one of the things that had me freaking out was a presentation I had to do. But we had already worked out that I was going to do the presentation one-on-one with my professor, and giving a presentation to an audience of one isn’t a huge deal. Trying to prepare for a presentation while depressed, overwhelmed, and apathetic, on the other hand, presents quite a few difficulties. I ended up doing the bare minimum I needed to, and even that felt like a major accomplishment with the way things have been going. Zeus, just showing up to class feels like a major accomplishment right now.

I told my psychiatrist about having noticed signs that my depression is getting worse, but they said that the fleeting suicidal thoughts I mentioned were something that can be normal with people who are under a lot of stress. Maybe I should have emphasized a bit more the part about these being specifically things I had noticed happening as precursors to my depression getting worse and ending up in the psych ward less than a year ago? Or that my fleeting suicidal thoughts specifically involved thinking about methods? Or that the last time I started having random suicidal thoughts without intention, the intention started showing up within a week or two? Anyway, I don’t really want to be more medicated, and it’s quite reasonable for a psychiatrist to say “let’s wait a bit and see if things get better before messing around with trying to switch you to a different medication”. It’s just, I felt like I wasn’t taken entirely seriously?

Then again, I don’t usually feel like I’m taken that seriously when talking about my suicidal ideation. I’ve never made an attempt before, and I know that’s one of the main criteria used in suicide risk assessment, as previous attempts are the strongest known predictor of future attempts (which isn’t actually saying that much–we don’t really know that much about how to predict who will or won’t attempt suicide, and there are totally people who die by suicide without ever showing any of the known warning signs). And however determined I am to be honest, I usually don’t quite manage to get across just how detailed of plans I have made, including doing research, more research, no-seriously-a-lot-of-research-like-do-you-have-any-idea-how-many-terrible-ways-there-are-to-try-to-kill-yourself-like-you-can-actually-survive-jumping-off-the-Golden-Gate-Bridge-or-shooting-yourself-in-the-head-if-you’re-really-unlucky, plus contingency planning, testing out each aspect of the plan, and rehearsing… But when someone doing a suicide assessment asks me if I have a plan, I usually just fidget uncomfortably and say “Ummm, I was thinking of maybe hanging myself? I guess.” And at most they ask enough questions to figure out what I was planning to hang myself with, and that yes I do have the materials for carrying out the plan at home.

So…. yea. Fleeting suicidal thoughts might be no biggie for most people, but with my past, I know it’s capable of becoming pretty big pretty quickly, and that when I’m thinking about killing myself without any intent of doing so (including when I have an active desire to continue being alive), that intent may well appear in the near future.

The is one other red flag thing I have noticed, which is that I frequently think about, and want, to cut myself. Self-injury is this thing that goes along with a number of mental illnesses. It’s not worrying in the way that suicidal ideation is. Self-injury, as odd as it might sound to people who don’t do it, is used as a coping mechanism. And there is a big, huge difference between using self-injury in order to cope and try to make things better, and thinking about killing yourself because you just want it all to stop. Anyway, self-injury is something I rarely do any more. So when I suddenly starting thinking about cutting myself all the time (or actually cut myself), I usually take that as sign that, hey, things aren’t going good right now!

So… hurray for twice weekly therapy sessions?

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2 thoughts on “Mental Health Update

  1. A few years ago, I spent forty-eight hours in a psychiatric hospital for suicidal ideation. Considering what you’re written, I’m surprised they didn’t check you in. My shrink probably would have. On the other hand, while I was in the hospital, I met someone who felt his attempts to get help were being ignored, so he just walked himself to the nearest emergency room. Actually, that’s what I did in a sense. I asked a couple of cops to take me. Cops are very obliging in that way if you say you want to kill yourself. I think they took it more seriously than my therapist.

    Or even for adhering to my bedtime so I don’t sleep through classes (strict bedtimes is the only reliable way I have found to wake up on time in the mornings, and even that can fail if I have a bout of insomnia).

    Funny, I’m exactly the same way. I don’t meet too many people who are like this.

    Anyway, I’m feeling better these days if you want to write or talk. From what you’ve written, it sounds like we might have a few similar issues.

    Sometimes good therapists can just be the wrong fit for a particular person. I actually had one therapist who I think I got along with too well on a personal level and I think that made him disinclined to see how badly I was doing. It sounds like you’re in school. The end of the semester might be a good time to maybe try a different psychiatrist or psychologist.

    One thing I found out over the course of several years, almost by accident, was that it was at least as important to address my anxiety as my depression.

    Liked by 1 person

    • Cops are very obliging if you tell them you want to kill yourself, yes. Sometimes too obliging. They aren’t exactly thoroughly trained in all the nuances of suicide assessment, after all (that’s something for the mental health professionals to do), and they take suicide very seriously. I’ve also heard that talking about the details of a suicide plan with someone on a crisis line is a good way to get some cops on your doorstep (for a well being check, or whatever they call it). Depending on the particular hotline and circumstances, they might or might not ask if you are okay with or desire this beforehand. The one time I called a suicide hotline, the guy offered to send over some cops for a well being check if I wanted him to, but it really was just an offer. There was no pressure to it. I declined.

      It has mostly been with people other than my therapist (whichever one I had at the time) that I have felt like I wasn’t taken as seriously as I should have been (possibly because they took my uncertainty and reluctance to be about my suicidal ideation, more than being about talking about my suicidal ideation). And usually they don’t ask quite the right questions, and I can’t quite bring myself to just offer up all the gritty details on my own. Or maybe they focus too much on how much intent is currently there. For myself, I know the level of intent is not necessarily indicative of how much risk I am at–if the intent isn’t quite there, but I’m rehearsing a well thought out plan, it would only take a momentary impulse to actually go through with it. Or, if I’m rehearsing and screw up in just the wrong way, the intent might not even need to be there at all.

      I do feel like my current therapist takes me seriously, although I’ve never had occasion to see how she deals with suicidal ideation, because I haven’t really had any since I started seeing her.

      The very worst experience I have had with not being taken seriously involved a suicide assessment with someone who dismissed the idea of inpatient hospitalization after concluding that I didn’t meet the criteria for involuntary hospitalization, and they wouldn’t know what to do with me anyway because I am trans. I left feeling more suicidal than when I went in, feeling terrified at the idea of hospitalization while trans, and feeling like hospitalization wasn’t even an option for me, specifically because I am trans, and if I ended up hospitalized anyway, it might do more harm than good (e.g. if they forced me into the gender segregated ward where I don’t belong, or if the staff kept misgendering me, or even if they put me in the right section and I got a roommate who had a problem with me, or just generally being put in a situation where my unusual anatomy and a lack of privacy combine to make a horrificly mortifying situation, such that the level of embarrassment and dysphoria might make for one of the worst experiences in my entire life). I did eventually find somewhere I could go that actually had a clue about trans people (the place where I actually did go inpatient the one time–by policy, they don’t give trans patients roommates), but until then, that experience added on an extra edge and source of desperation anytime I was thinking about suicide. Extra sources of desperation are the opposite of what you want when feeling suicidal…

      Anyway, talking might be good. Possibly especially because I’m not at a crisis point currently. My email is midoriskies1@gmail.com if you want to email. Though I probably should mention, I don’t check it too often if I’m not expecting any email.

      Like

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